Self-Mutilation and Suicidal Behavior in Borderline Personality Disorder

The relationship of self-mutilation to suicidal behavior was studied in 108 borderline inpatients (defined by the Diagnostic Interview for Borderline Patients). Patients with histories of self-mutilation were compared to those with no self-mutilation on diagnostic comorbidity, symptom patterns, prior suicidal behaviors, and attempt characteristics, including number of attempts, seriousness of intent, and medical lethality. Self-mutilation was found in 63% of patients, suicidal attempts in 75.7%. Patients with self-mutilation were significantly younger and more symptomatic than controls, and had more serious suicidal ideation and recent suicide attempts. On the DIB they had significantly more manipulative suicide threat or effort, depersonalization and drug-free hallucinations or delusions. They tended toward more depression and schizotypal symptoms but less anger and assaultiveness compared to non-mutilating patients. Histories of manipulative suicide attempts were characteristic of self mutilating patients; however, self mutilation was not associated with increased seriousness of intent or lethality of suicide attempts.